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Biomedical subjects

S Gustavsson

Publications and source records attributed to S Gustavsson.

At least 73 records · Page 4Linked to original sources
PubMed1987

The "epigastric distress syndrome". A possible disease entity identified by history and endoscopy in patients with nonulcer dyspepsia.

Nonucler dyspepsia lacks a clear definition, and probably conceals several entities under this heading. It seems appropriate to deal separately with symptoms likely to be elicited from the upper digestive tract. Therefore, we propose "epigastric distress syndrome" (EDS) as a designation for chronic or recurrent epigastric pain without any anatomical antecedents and without concomitant symptoms consistent with established criteria of the irritable bowel syndrome. In this study 185 dyspeptic patients with a tentative diagnosis of EDS, based on symptoms and negative upper endoscopy, underwent laboratory screening, peroral cholecystograms, ultrasound scanning of the liver, biliary tract, and pancreas, biopsies from the distal part of the duodenum, and acid secretory tests. There were very few pathological findings. Five patients had gallstones. No single case of chronic pancreatitis or celiac disease was disclosed. Thus, EDS seems to be a "safe" diagnosis, and it is not unreasonable to assume that it could represent a disease entity. Although many patients had symptoms closely similar to those in duodenal ulcer, the mean basal and maximal acid output in this patient category did not differ from that observed among healthy subjects.

Adolescent↗
PubMed1987

Self-rating of pain in nonulcer dyspepsia. A methodological study comparing a new fixed-point scale and the visual analogue scale.

Little attention has been paid to methodological aspects in the recording of gastrointestinal symptoms. We compared a new fixed-point scale for the self-recording of pain intensity with steps operationally linked to behavioral events and with additional monitoring of pain duration--termed the "duration-intensity-behavior scale" (DIBS)--with the visual analogue scale (VAS) in 32 patients with nonulcer dyspepsia. After randomization, the patients either recorded pain intensity (VAS) or pain intensity and duration (DIBS) four times daily during a 4-week period for 1 preliminary week without medication, followed by 3 weeks of antacid treatment. For both scales there was a high degree of compliance, and they seemed equally reliable and sensitive to changes in pain experience. Since DIBS yields more clinically useful information, this scale appears to be preferable for the monitoring of gastrointestinal pain.

Adult↗
PubMed1986

Absence of therapeutic benefit from antacids or cimetidine in non-ulcer dyspepsia.

We randomly assigned 159 patients with non-ulcer dyspepsia, defined as chronic or recurrent epigastric pain without concomitant symptoms of the irritable bowel syndrome and with no evidence of organic disease, to treatment for three weeks with an antacid suspension one and three hours after meals, 400 mg of cimetidine twice a day, or placebo, according to a double-blind, double-dummy model. The intensity and duration of epigastric pain were recorded by the patients four times daily during a one-week period without therapy and during the three weeks of treatment. The mean reduction in pain intensity after three weeks in the placebo group was 25 percent. Neither antacid nor cimetidine treatment resulted in more than a 4 percent better effect. The reduction of pain was statistically significant (P less than 0.01) in all three groups. The time course of the pain scores in the groups receiving active drugs followed closely those in the placebo group, and there were no significant differences between the groups at any stage of the treatment. We conclude that the neutralization or suppression of gastric acid is of no clinical value in patients with this syndrome.

Adolescent↗
PubMed1986

Symptomatic cimetidine treatment of duodenal and prepyloric ulcers.

In a randomized trial, 75 patients with an endoscopically confirmed and symptomatic duodenal (N = 50) or prepyloric (N = 25) ulcer were allocated to cimetidine treatment (1 g/day) either regularly for four weeks (standard treatment group) or regularly for a minimum of one week and thereafter only until the symptoms were controlled (symptomatic treatment group). The four-week healing frequencies in the standard and symptomatic treatment groups were 72 and 67%, respectively. The difference +/- 95% confidence limits was 5 +/- 21%. Prospective recording of pain revealed that the two treatment regimens were about equally effective in relieving symptoms during weeks 2-4. Patients with unhealed ulcers reported pain during the day and night significantly more often than those with healed ulcers. In the symptomatic treatment group the average patient saved 11 days of cimetidine medication during weeks 2-4. We believe that disappearance of symptoms might be a valuable means of deciding when treatment for peptic ulcers can be discontinued. Provided its efficacy and safety can be further confirmed, symptomatic treatment might become a practical and possibly a money-saving mode of ulcer management, which should also be applicable to the ulcer regimens of tomorrow.

Adult↗
PubMed1986

Excess sick-listing in nonulcer dyspepsia.

The pattern of sick leave among 88 patients with nonulcer dyspepsia (NUD) and 73 patients with duodenal/prepyloric ulcer disease (DU/PPU) was studied by means of a computerized register held by the National Health Insurance Service, which covered all instances in which patients received cash benefit due to sickness. Patients with either NUD or DU/PPU were associated with a considerably increased risk of being sick-listed. The risk of needing sick days was significantly higher in the NUD group than in the ulcer group (p less than 0.02), and the NUD patients had on an average 2.6 times as many sick days requiring compensation as the corresponding background population. The ulcer patients were absent from work mainly because of their abdominal symptoms; other reasons for sick-leave were rare. On the other hand, the sick-listing among NUD patients was due to a host of complaints, dominated not by abdominal but by musculoskeletal symptoms. Thus, it seems as if several factors other than dyspepsia contribute to the disposition towards absenteeism among NUD patients. Psychosocial factors might play an even greater role in NUD than in DU/PPU patients. The present study contradicts the concept of NUD and DU/PPU as different manifestations or stages of the same disease entity. In view of the high prevalence of NUD, the substantial amount of sickness absenteeism poses a considerable economic burden on society.

Absenteeism↗
PubMed1986

Effect of azodisal sodium on the distribution of a transit marker in the small bowel of the fasted rat.

The effect of azodisal sodium (ADS) on the transit of a radioactive marker in the small bowel was compared with that of 5-ASA and sulfasalazine (SASP). The bile-excreted radiopharmaceutic 99mTc-HIDA was infused intravenously for 1 h into conscious rats with an intact alimentary tract and the radioactivity along the excised gastrointestinal specimen was subsequently determined. After administration of ADS (12.5 mg/rat), 5-ASA and SASP, the distribution of radioactivity was characterized by localized peaks of radioactivity separated by fairly long empty regions. As judged from experience this pattern represents the fasting state under control conditions. Administration of ADS (60 and 120 mg/rat) resulted in a distribution along the small bowel without any apparent peaks or empty regions. The transport rate of the front of the tracer was enhanced by ADS at higher doses but not by 5-ASA or SASP. Intravenous administration of ADS did not affect the transit, indicating the importance of the presence of ADS in the gut lumen. Prostaglandin release does not seem to be a probable mediating mechanism since pretreatment with indomethacin did not abolish the effect of ADS on the interdigestive transit pattern.

Aminosalicylic Acids↗
PubMed1986

Basal and food-stimulated levels of gastrin and pancreatic polypeptide in non-ulcer dyspepsia and duodenal ulcer.

Basal and food-stimulated levels of gastrin and pancreatic polypeptide (PP) were studied in 86 patients with non-ulcer dyspepsia (NUD), defined as chronic or recurrent epigastric pain without anatomical antecedents and without concomitant symptoms of irritable bowel. Thirteen patients with endoscopically confirmed duodenal ulcer disease (DU) and 13 healthy subjects constituted the reference groups. The mean basal gastrin concentration was moderately but significantly (p less than 0.05) higher in the NUD group than in the reference groups (24.3 +/- 1.6 (SEM) pmol/l in NUD, compared with 15.0 +/- 1.5 and 13.6 +/- 1.0 pmol/l among DU patients and healthy subjects, respectively). The well-established postprandial hypergastrinemia in duodenal ulcer patients could be confirmed in this study, and their gastrin response to food was significantly (p less than 0.01) greater than the responses observed both in healthy subjects and in NUD patients. The two latter groups did not differ significantly with regard to gastrin increments, but there was a tendency towards greater increases in the NUD group. A significantly (p less than 0.05) enhanced PP response to the test meal was observed among the DU patients, whereas the response pattern in NUD was closely similar to that in healthy subjects.

Adult↗
PubMed1985

A simple one-step procedure for the separation of calpain I, calpain II and calpastatin.

The soluble fraction from rabbit brain was adsorbed on a column of phenyl-Sepharose. By applying a linear gradient with decreasing salt concentration and increasing pH, it was possible to separate calpain I and calpain II from each other and from the endogenous inhibitor calpastatin. Both enzymes were capable of degrading endogenously labelled neuronal proteins, including slowly axonally transported soluble proteins and rapidly transported membrane-bound proteins, as well as casein.

Calcium↗
PubMed1985

A method for in vitro studies on acid formation in human parietal cells. Stimulation by histamine, pentagastrin and carbachol.

Cells were isolated from human gastric mucosa on a large scale from gastric resection specimens and on a microscale from endoscopic biopsies by sequential incubations with pronase and collagenase. The accumulation of aminopyrine (AP) was used as an index of acid production in the parietal cells. Basal accumulation was about 0.2 pmol AP/10(4) parietal cells. Addition of histamine, db-cAMP, pentagastrin and carbachol increased the aminopyrine accumulation. Maximal accumulation was of the order of 1000-2800% of the control and was obtained after stimulation by 10(-4) M histamine and by 10(-3) M db-cAMP. Stimulation by pentagastrin and by carbachol reached 200 to 350% of the control. EC50 was 2 X 10(-6) M for histamine, 10(-8) M for pentagastrin, and 4 X 10(-6) M for carbachol. Human parietal cells were enriched from a mixture of gastric mucosal cells by isopycnic centrifugation on density gradients of Percoll. A parietal cell fraction with a purity of 83% was obtained. The density of human parietal cells was estimated to 1.06 g . ml-1.

Adult↗
PubMed1985

Omeprazole, cimetidine, and ranitidine: inhibition of acid production in isolated human parietal cells.

The antisecretory properties of omeprazole, cimetidine, and ranitidine were studied in vitro, using human gastric mucosal cells, which were obtained by sequential pronase and collagenase incubation of small tissue specimens obtained by endoscopic biopsy. Acid production was measured as the accumulation of radioactive aminopyrine in the acid compartments of the parietal cells. Acid production was stimulated via H2-receptors by histamine (10(-4) M or 5 X 10(-6) M) and via intracellular mechanisms by db-cAMP (10(-3) M). Omeprazole induced a dose-dependent inhibition of acid production for all stimulators (IC50 = 2 X 10(-7) M and 3 X 10(-8) M with high and low concentrations of histamine, respectively, and 5 X 10(-6) M with db-cAMP). The H2-receptor antagonists dose-dependently inhibited the histamine-stimulated acid production (IC50 for cimetidine = 10(-5) M and 10(-6) M and for ranitidine = 10(-5) M and 2 X 10(-7) M for high and low concentrations of histamine, respectively). Neither cimetidine nor ranitidine inhibited acid production after intracellular stimulation with db-cAMP. Omeprazole reduced the aminopyrine accumulation stimulated by histamine (10(-4) M) already within 5-10 min, whereas cimetidine (10(-3) M and ranitidine (10(-4) M) required 20-30 min. The unstimulated level of acid production was also inhibited by omeprazole but not by the H2-receptor antagonists.

Adult↗
PubMed1985

Dyspepsia. Definition and discussion of nomenclature.

Dyspepsia stands for a constellation of symptoms referrable to the upper gastrointestinal tract. However, the term dyspepsia is too vague to be useful in scientific work unless critically defined. In many cases dyspepsia coincides with the irritable bowel syndrome. An increased use of endoscopy and the possibility of prompt symptom relief in peptic ulcer by treatment with H2-receptor antagonists have focused the interest on patients with ulcer-like dyspepsia but in whom there is no evidence of ulcer disease. This large group of patients deserves further nosologic classification and there is a strong need of pathophysiologic and interventional studies.

Colonic Diseases, Functional↗
PubMed1985

The Diagnosis and Therapy Survey October 1978-March 1983, health care consumption and current drug therapy in Sweden with respect to the clinical diagnosis of gastritis.

Demographic epidemiology, current drug therapy and the health care resources required by patients clinically considered to have gastritis were studied during a four and a half year period-October 1978 to March 1983. The investigation was based on data from the Diagnosis and Therapy Survey, an on-going nation-wide sample study covering all out-patient care in Sweden. Gastritis was found to account for 1.9% of all out-patient consultations and for 30% of those for gastrointestinal disorders. The corresponding figures for peptic ulcer disease were 0.2% and 4%, respectively. The estimated minimum number of annual consultations for gastritis was 47 per 1,000 inhabitants. The majority of the consultations were dealt with in general practice, where gastritis was the fifth most common diagnosis. Drug therapy was considered to be indicated in 92% of the consultations. Antacids were prescribed in 77%, anticholinergic/spasmolytic drugs in 36% and histamine H2-receptor antagonists in 4%. The clinical diagnosis of gastritis was found to be the major indication for antacids and anticholinergic drugs and accounted for a substantial proportion of H2-receptor antagonist prescriptions. The patient groups with gastritis and duodenal ulcer showed a similar age distribution, with a mean age of about 50 years. In the gastritis group, the two sexes were equally represented, but in the duodenal ulcer group there was a predominance of men. The results of the Diagnosis and Therapy Survey indicate that the patient group with symptoms traditionally denoted as gastritis in clinical practice constitutes a major health care problem in our community.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Social and economic effects of non-ulcer dyspepsia.

An attempt was made to estimate the total costs of non-ulcer dyspepsia (NUD) in Sweden by extracting information from different available sources. After extrapolation of figures from the in-patient register of the University Hospital in Uppsala to the whole of Sweden, the total annual expenditure for in-patient care was estimated to be 10.3 million SEK. Calculations of costs for out-patient care and drugs were based on data from a nation-wide sample survey, and the total expenses were estimated to be 197.5 million SEK and 60 million SEK, respectively. Among indirect social costs, economic losses due to death and early retirement were found to be comparatively moderate. Production loss due to short-term sick-leave was by far the most dominant item among all social costs. In a study of 88 consecutive patients with NUD, it was revealed that the average NUD patient was responsible for 26 more days of lost production than the average employee. Thus, the total annual cost for short-term sick-leave was estimated to be 2,496 million SEK. The grand total of these calculations amounts to no less than 2,786 million SEK. Although affected by a considerable degree of uncertainty, the presented figures point to important economic consequences for society.

Absenteeism↗
PubMed1985

Methodological aspects of clinical trials in non-ulcer dyspepsia with special reference to selectional factors.

The sampling process preceding a clinical trial is associated with numerous fallacies. This is especially true in non-ulcer dyspepsia, which is a prevalent but poorly defined condition, probably with heterogenic etiologies. Therefore, in order to make subsequent inferences possible, it is crucial that rigorous criteria for adherence to the target population--and the studied sample--are established in advance. Several factors, however, preclude a strictly random sample from the target population. Firstly, only those who find their way to medical services are included in trials, and different circumstances may affect the patient's decision to seek medical advice. Secondly, the doctor's decision to refer a patient to a study is influenced by a number of factors that might introduce bias. As an example, an on-going study of non-ulcer dyspepsia is presented. With the application of strict symptomatic criteria, and the exclusion of circumscribed organic lesions of the upper gastrointestinal tract by means of endoscopy, it was possible to define a population in which very few additional pathological findings were made at thorough diagnostic work-up.

Clinical Trials as Topic↗